With winter approaching the temperatures are dropping and the potential for hypothermia increases. Hypothermia is defined as " a condition in which the...

by Kimberly Allen, RN

Hypothermia

With winter approaching the temperatures are dropping and the potential for hypothermia increases. Hypothermia is defined as ” a condition in which the core temperature drops below the required temperature for normal metabolism and body functions.” Normal body temperature is usually maintained around 98-100F by the hypothalamus through a process known as thermoregulation. Hypothermia occurs when you are exposed to the cold and your internal temperature regulator is unable to keep up with the heat your body is losing.

In the past, homeless people have been the most frequently affected by hypothermia, however, now recreational exposure to the cold accounts for most cases of hypothermia. In the US, there are over 1500 cases of hypothermia with approximately 650 deaths every year due to hypothermia. People that are 65 years of age and older are more susceptible to hypothermia because the body’s ability to detect cold and regulate temperature decreases with age. The very young are also more susceptible because children lose heat much faster than adults also many children tend to forget the cold when they are playing because they’re focusing on having fun and not aware of the potential dangers. Also, people that have conditions that interfere with judgement like mental illness or dementia are susceptible to hypothermia. I once had an elderly patient with Alzheimer’s disease that walked out of her house in the middle of the night in the middle of winter with below zero temperatures in her night gown and slippers. The police found her and took her to the local emergency room. She was very cold but fortunately was found before hypothermia set in. Alcohol and drug abuse cal also contribute to hypothermia because it dilates your blood vessels making you feel warm and increasing the heat loss from your body. There are also numerous other health conditions as well as medications that can increase your risk of developing hypothermia.
Hypothermia occurs when your core temperature falls below 95F. Your core temperature can drop for many reasons like not wearing clothing that is warm enough for the weather outside, or staying outside to long. getting wet whether it’s from falling into water or increased perspiration so that the clothes next to your body are wet will cause you to become hypothermic because cold water transfers heat from your body much faster than cold air. Being outside unprotected from the wind can not only cause hypothermia but also lead to frostbite.
Left untreated hypothermia can lead to complications including frostbite, chilbains and gangrene as well as trench foot. As your body temperature begins to drop shivering starts first. shivering is our body’s built in defense mechanism against the cold. If you are shivering constantly that is an early sign that hypothermia is setting in. The next thing you’ll notice is your speech will get slurred and you’ll be clumsy and stumbling having poor coordination. As your core temperature continues to drop you’ll become confused and your judgment will become impaired, eventually you’ll get very sleepy with no energy. Most deaths from hypthermia occur because the person fell asleep and literally froze to death.
Treatment for hypothermia involves getting out of the cold and/or find shelter from the wind. If you are wet remove all your wet clothing and wrap yourself in a warm blanket, making sure to cover the top of your head too, only your face should be exposed. Drinking warm non-alcoholic beverages will also help increase your body temperature. Should you find someone that is hypothermic it’s important to be very gentle when assisting them. If you are in an area where you can call 911 do so immediately then do what you can to warm the person until help arrives. If you are outside and seeking medical help is not a viable option first get the person off the cold ground onto a blanket ore something and if possible build a fire for a heat source and always monitor the persons breathing.
Prevention of hypothermia especially in the winter is crucial to survival. If you follow the C-O-L-D guidelines you’ll significantly reduce your risk of developing hypothermia.
C-cover, make sure you always wear a hat and use mittens instead of gloves.
O-overexertion, avoid overexerting causing you to sweat alot and dampen your clothes.
L-layers, wear layers of lightweight clothing.
D-dry stay as dry as possible, especially your feet and hands.
Children should always wear an extra layer of clothing and only spend short periods of time outside coming in to warm frequently.

Frostbite

Frostbite is an injury that is caused by freezing. Freezing causes localized damage to skin as well as other tissues. Frostbite usually occurs to exposed areas as well as those parts of the body furthest from the heart like the feet and toes. In the past frostbite has been more of a problem associated with the military, however, in recent years it has become more of a civilian problem. Many more people are engaging in winter sports like skiing and snowmobiling as well as ice fishing. If people do not prepare properly and respect the cold they are in serious danger of suffering from hypothermia and/or frostbite.
Frostbite occurs because as the body temperature drops the blood vessels constrict or narrow, reducing blood flow which leads to freezing and death of the skin and tissues in the area affected. frostbite is measured in degrees, there are four degrees of frostbite, each with varying degrees of pain;
1. First degree frostbite is frequently referred to as “frost nip”. In first degree frostbite only the surface skin is affected. As it develops you’ll feel pain and itching and the skin becomes numb with patches of red, white, and/or yellow or gray. first degree frostbite usually doesn’t cause permanent damage, however, you can develop permanent insensitivity to both cold and heat.
2. Second degree frostbite occurs when the exposure is more severe, it involves only the skin while the deeper tissues remain unaffected. In second degree frostbite the skin usually blisters approximately 1-2 days after exposure. They may harden and turn black appearing much worse than they are. The injury from this degree of frostbite usually heal in a month or so, however, you may develop a permanent insensitivity to both cold and heat.
3. In both third and fourth degree frostbite the muscles and tendons as well as the blood vessels and nerves freeze. The skin becomes hard and waxy in appearance. You will lose the use of the affected area at least temporarily, and if the frostbite is severe it could be permanent. Nerve damage depending on the severity usually results in loss of sensation. If the damage is extreme affected areas like fingers and toes may need to be amputated. Depending on the extent done by the freezing process it can take month to determine how much damage has been done.
Treatment for any degree of frostbite should begin as soon as you notice symptoms. The most important thing to remember is to warm the affected area slowly. The skin will get red and become quite painful as it thaws. Some of the things you can do immediately is cover exposed areas like your face and ear’s or if your hands are frostbitten tuck them under your armpits. Get inside out of the cold and wind as soon as possible and never rub the affected area. Frostbitten feet and/or hands can be put in warm, not hot, water and other areas should wrapped or covered in a warm blanket. Never use a direct heat source like a stove, fireplace or even a heating pad because they can burn your skin before you can feel it and realize what has happened. If at all possible do not walk on feet and/or toes that are frostbitten as it can cause further damage to the affected tissues. If the numbness and pain continue or blisters develop seek medical attention.
Prevention is always the best defense against any illness and frostbite and other cold related conditions are no different. always dress in layers and appropriate for the weather. I know many people prefer gloves but mittens will keep your hands warmer because the fingers can touch each other keeping each other warm. Wear waterproof footwear and 2 pairs of socks, the first pair should be synthetic material to keep the moisture away from the skin and the second pair should be wool for insulation. Keep your head, face and ears covered at all times. I know everyone carries a cell phone these days but it’s still a good idea to take a friend in case there is no service and you need help.

Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at mussatti3@gmail.com.